NPIMap

Organization Active NPI

Infectious Diseases Associates of North Florida, P.a.

  • Legal Medicine
  • St Augustine, FL
National Provider Identifier
1841384005
Registry record updated Nov 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Legal MedicineTaxonomy code 173000000X
License
ME80064 Issued in FL
Legal business name
INFECTIOUS DISEASES ASSOCIATES OF NORTH FLORIDA, P.A.
Practice address
100 Whetstone PL
Suite 205
St Augustine, FL 32086-5774
Phone
(904) 819-9925
Fax
(904) 819-9926
NPI assigned
Oct 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Monali Manikal, M.D.NPI 1447276852
Title
Manager
Phone
(904) 819-9925

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Legal MedicineGroup: 193200000X MULTI-SPECIALTY GROUP 173000000X ME80064 FL Primary

Addresses

Primary practice location

100 Whetstone PL
Suite 205
St Augustine, FL 32086-5774

Mailing address

1093 A1A Beach Blvd
PMB 415
St Augustine, FL 32080-6733
Phone (904) 819-9925

Other identifiers 1

IdentifierTypeStateIssuer
259185500MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050610000224 FL Part B Supplier - Clinic/Group Practice 4880638873 Receives reassigned benefits from 7 practitioners
Practice locations: Saint Augustine, FL; St Augustine, FL
O20150310002222 GA Part B Supplier - Clinic/Group Practice 4880638873 Receives reassigned benefits from 2 practitioners
Practice locations: Lakeland, GA; Nashville, GA; Valdosta, GA; Waycross, GA

National Provider Directory

National Provider Directory

Locations

65 Silver Ln
St Augustine, FL 32084
Phone (904) 217-2148

100 Whetstone Pl
Ste 205
St Augustine, FL 32086
Phone (904) 429-9892

101 Whitehall Dr
Ste 104
St Augustine, FL 32086
Phone (904) 829-6591

101 Whitehall Dr
Ste 103
St Augustine, FL 32086

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320278400000",
    "number": "1841384005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1093 A1A BEACH BLVD",
            "address_2": "PMB 415",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320806733",
            "telephone_number": "904-819-9925",
            "fax_number": "904-819-9926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WHETSTONE PL",
            "address_2": "SUITE 205",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865774",
            "telephone_number": "904-819-9925",
            "fax_number": "904-819-9926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INFECTIOUS DISEASES ASSOCIATES OF NORTH FLORIDA, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2011-11-03",
        "status": "A",
        "authorized_official_last_name": "MANIKAL",
        "authorized_official_first_name": "MONALI",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "904-819-9925",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Legal Medicine",
            "state": "FL",
            "license": "ME80064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "259185500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.